Public Health Agency



The Scabies mite burrows and lays eggs under the outer layer of skin (epidermis). The faeces deposited in the burrow cause an allergic reaction, leading to a rash around the site of the burrow. Each burrow contains a fecund female which lays eggs; after three or four days the baby mites (larvae) hatch and move to the surface of the skin where they mature into adults.

 Scabies thrive in warm places, such as skin folds, between the fingers, under the fingernails or around the buttocks. They can also be found under jewellery such as rings and wrist watches. The incubation period for scabies is up to eight weeks i.e. the length of time it can take for the symptoms of scabies to appear after initial infection. A simple skin scrape and examination under low power microscopy will reveal the adult and eggs.

Crusted scabies (Norwegian scabies) is a rare form of the disease which affects people with impaired immune systems or the elderly, disabled or debilitated. It is a hyper-infestation, with thousands or millions of mites present in scales of exfoliated skin; people with crusted scabies may not show the usual signs and symptoms such as rash or itching. Individuals with crusted scabies are more contagious and can spread the infestation easily both, by direct skin to skin contact or by contamination of items such as their clothing, bedding and furniture.


  • Scabies is usually spread through prolonged periods of skin to skin contact with an infected person
  • Transmission by casual contact such as a handshake or a hug is unlikely
  • Scabies can also spread through sexual contact
  • Crusted scabies is highly contagious and in addition to transmission by direct contact, is easily transmissible via bedding, towels, clothes and upholstery
  • Transmission can occur before the patient is symptomatic
  • Diagnosis is difficult and may require consultation with a dermatologist

Management of Scabies

New admissions

  • If a patient presents with an itching rash diagnosed as scabies, they should be cared for in a single room with contact precautions (insert link to contact precautions)
  • Precautions should be maintained for 24 hours after the completion of appropriate treatment
  • If the patient is admitted from a Care Home facility, the Infection Prevention & Control Team (IPCT) and the Public Health Agency (PHA) should be informed

Two or more cases occur in a healthcare environment

  • If patients or staff members present with an unexplained rash or itching, scabies must be considered.
  • Once a diagnosis of Scabies is confirmed the following actions should be taken:

-        In hospital inform the Infection Prevention & Control Team

-        In community settings, inform the unit manager, GP and/or the Public Health Agency as appropriate

-        Generate a list of affected persons. If staff are involved the Occupational Health Department must be alerted

-        All affected patients and staff should commence treatment

-        The movement of staff to and from the affected area should be restricted if possible

-        The movement of patients to and from the affected area must be restricted until all patients have been treated

-        Inform the relatives of symptomatic patients of the situation and advise them to contact their GP regarding treatment

Infection Control Measures within an Acute Hospital Setting

  • Isolate the patient in a single room with contact precautions until treatment has been completed and rash has dried and crusted over
  • Staff should wear plastic aprons and disposable gloves when carrying out treatment or patients personal hygiene need
  • Bath/ shower patient thoroughly. Allow the patient to cool down prior to painting the scabicide lotion over the entire body
  • Laundry is to be handled as ‘foul or infected’; placed into an alginate bag, then into a secure outer bag
  • All items used for handling clothes and bed linen and in the application of the scabicide should be placed into clinical waste bags
  • Decontaminate all share equipment between each use
  • A ‘contact precautions’ sign may be displayed (according to local policy)

Infection Control Measures within a Residential Care Home

  • When a resident is diagnosed as suffering from scabies the nurse in charge should ensure that the residents GP is aware and also inform the Public Health Agency (PHA)
  • Patients with crusted scabies should be isolated until treatment has been completed
  • If two or more cases are identified, the decision to treat all staff and clients is based on a risk assessment in consultation with the PHA  
  • Treating all clients and staff is an intensive process and advice must be sought from an Outbreak team before initiating
  • Staff (or family members) should wear plastic aprons/long sleeved disposable gowns and disposable gloves when carrying out intimate care where there is likely to be significant skin contact
  • Bath/shower patient thoroughly. Allow the patient to cool down prior to painting the scabicide lotion over the entire body
  • Laundry for Crusted Scabies: machine wash (at 60°C or above or at the highest temperature suitable for the garment) clothes, towels and bed linen on the day of application of the first treatment
  • Disposable gloves, aprons/long sleeved gowns and waste used for handling clothes etc. and in the application of the scabicide should be placed into yellow clinical waste bags

NOTE: the itch may persist for two weeks after treatment and can be relieved by antipruritics. Do not retreat simply because of itching.

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